A 2-year-old ingests an unknown quantity of organophosphate pesticide at home. On arrival: miosis, excessive secretions, bradycardia, and fasciculations. After atropinisation the child develops agitation and confusion despite adequate secretion drying. What does this indicate?
- A Atropine overdose causing central anticholinergic syndrome
- B Adequate atropinisation; these are nicotinic effects not reversed by atropine ✓
- C Organophosphate-induced delayed polyneuropathy
- D Intermediate syndrome onset
Correct answer: B. Adequate atropinisation; these are nicotinic effects not reversed by atropine
Explanation
Atropine reverses muscarinic effects of organophosphate poisoning (secretions, bradycardia, miosis) but does NOT reverse nicotinic effects (muscle fasciculations, weakness, tachycardia, agitation at nicotinic CNS receptors). Agitation after secretion drying indicates nicotinic CNS toxicity, which requires pralidoxime (2-PAM) as an oxime to regenerate acetylcholinesterase. Intermediate syndrome appears 24–96 hours after acute phase resolution. OPIDP (delayed neuropathy) occurs weeks later.
Reference: Ghai Essential Pediatrics, 10th ed.
High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP
Written and medically reviewed by the StethoPrep medical team.